A BRIEF HISTORY OF MEDICINE

By Tim Lambert

MEDICINE IN THE ANCIENT WORLD

Medicine among Primitive Peoples

The first evidence of surgery is skulls from the stone age. Some adults had holes cut in their skulls. At least sometimes people survived the 'operation' because the bone grew back. We do not know the purpose of the 'operation'. Perhaps it was performed on people with head injuries to release pressure on the brain.

In the 19th and early 20th centuries anthropologists studied primitive societies. Among them treatment for injury and sickness was a mixture of common sense and magic. People knew, of course, that falls cause broken bones and fire causes burns. Animal bites or human weapons cause wounds. Primitive people had simple treatments for these things e.g. Australian Aborigines covered broken arms in clay, which hardened in the hot sun. Cuts were covered with fat or clay and bound up with animal skins or bark. However primitive people had no idea what caused illness. They assumed it was caused by evil spirits or magic performed by an enemy. The 'cure' was magic to drive out the evil spirit or break the enemies spell.

Ancient Egyptian Medicine

In about 3000 BC the curtain rises on Egyptian civilization. In a civilized society some people did specialized jobs. One of these was the doctor.

The first doctor known to history was Sekhet-eanach who 'healed the pharaoh's nostrils'. (We do not know what was wrong with them). The second doctor we know of was Imhotep (c. 2,600 BC) who was vizier or prime minister to the pharaoh. He was also a doctor and he was so famous that after his death he was worshiped as a god.

Much of Egyptian medicine still relied on magic. However at least they could keep written records of which treatments worked and which did not. In this way medicine could advance.

The earliest known medical book is the Ebers Papyrus, which was written about 1500 BC.

Egyptian doctors used a huge range of drugs obtained from herbs and minerals. They were drunk with wine or beer or sometimes mixed with dough to form a 'pill'. Egyptian doctors also used ointments for wounds and they treated chest complaints by getting the patient to inhale steam.

The Egyptians believed that the human body was full of passages that acted like irrigation canals. The Egyptians knew that irrigation canals sometimes became blocked. They reasoned that if the passages in a human body became blocked it might cause illness. To open them Egyptians used laxatives and induced vomiting.

However the Egyptians still believed that spells would help the sick and they carried amulets to ward off disease. Nevertheless they were beginning to seek a physical cause for illness.

The Egyptians did have some knowledge of anatomy from making mummies. To embalm a dead body they first removed the principal organs, which would otherwise rot.

However Egyptian surgery was limited to such things as treating wounds and broken bones and dealing with boils and abscesses. The Egyptians used clamps, sutures and cauterization. They had surgical instruments like probes, saws, forceps, scalpels and scissors.

They also knew that honey helped to prevent wounds becoming infected. (It is a natural antiseptic). They also dressed wounds with willow bark, which has the same effect.

Moreover the Egyptians were clean people. They washed daily and changed their clothes regularly, which must have helped their health.

Ancient Greek Medicine

The roots of modern medicine are in ancient Greece. On the one hand most Greeks believed in a god of healing called Asclepius. People who were ill made sacrifices or offerings to the god. They then slept overnight in his temple. They believed that the god would visit them in their sleep (i.e. in their dreams) and when they woke up they would be healed.

At the same time Greek doctors developed a rational theory of disease and sought cures. However one did not replace the other. The cult of Asclepius and Greek medicine existed side by side.

Medical schools were formed in Greece and in Greek colonies around the Mediterranean. As early as 500 BC a man named Alcamaeon from Croton in Italy said that a body was healthy if it had the right balance of hot and cold, wet and dry. It the balance was upset the body grew ill.

However the most famous Greek doctor is Hippocrates (C.460-377 BC). (Although historians now believe that he was much less famous in his own time that was once thought. It is believed that many of the medical books ascribed to him were actually written by other men). Hippocrates stressed that doctors should carefully observe the patients symptoms and take note of them. Hippocrates also rejected all magic and he believed in herbal remedies.

A number of Greeks speculated that the human body was made up of elements. If they were properly balanced the person was healthy. However if they became unbalanced the person fell ill.

Finally Aristotle (384-322 BC) thought the body was made up of four humors or liquids. They were phlegm, blood, yellow bile and black bile. If a person had too much of one humor they fell ill. For instance if a person had a fever he must have too much blood. The treatment was to cut the patient and let him bleed.

The Greeks also knew that diet and exercise and keeping clean were important for health.

Later Alexander the Great conquered Egypt. In 332 BC he founded the city of Alexandria and a great medical school was established there. Doctors in Alexandria dissected human bodies and they gained a much better knowledge of anatomy. However little progress was made in understanding disease.

Roman Medicine

The Romans conquered Greece and afterwards doctors in the Roman Empire were often Greeks. Many of them were slaves. Doctors had low status in Rome. However the state paid public doctors to treat they poor. The Romans also had hospitals called valetudinaria for their wounded soldiers.

Later in Roman times Galen (130-200 AD) became a famous doctor. At first he worked treating wounded gladiators. Then in 169 AD he was made doctor to Commodus, the Roman Emperor's son. Galen was also a writer and he wrote many books.

Galen believed the theory of the four humors. He also believed in treating illness with opposites. So if a patient had a cold Galen gave him something hot like pepper.

Galen was also interested in anatomy. Unfortunately by his time dissecting human bodies was forbidden. So Galen had to dissect animal bodies including apes. However animal bodies are not the same as human bodies and so some of Galen's ideas were quite wrong. Unfortunately Galen was a very influential writer. For centuries his writings dominated medicine.

In the first century BC a Roman named Varro suggested that tiny animals caused disease. They were carried through the air and entered the body through the nose or the mouth. Unfortunately with no microscopes there was no way of testing his theory.

The Romans were also skilled engineers and they created a system of public health. The Romans noticed that people who lived near swamps often died of malaria. They did not know that mosquitoes in the swamps carried disease but they drained the swamps anyway.

The Romans also knew that dirt encourages disease and they appreciated the importance of cleanliness. They built aqueducts to bring clean water into towns.

They also knew that sewage encourages disease. The Romans built public lavatories in their towns. Streams running underneath them carried away sewage.

MEDICINE IN THE MIDDLE AGES

The eastern half of the Roman Empire continued and later Muslims took their knowledge of medicine from there. In the 9th century a man named Hunain Ibn Ishaq traveled to Greece collecting Greek books. He then returned to Baghdad and translated them into Arabic. Later the same works were translated into Latin and passed back to western Europe.

In the Middle Ages learning flourished in Europe. Greek and Roman books, which had been translated into Arabic were now translated into Latin. In the late 11th century a school of medicine was founded in Salerno in Italy. (Women were allowed to study there as well as men). In the 12th century another was founded at Montpellier. In the 13th century more were founded at Bologna, Padua and Paris. Furthermore many students studied medicine in European universities. Medicine became a profession again.

In the Middle Ages medicine was dominated by the ideas of Galen and the theory of the four humors. Medieval doctors were great believers in blood letting. Ill people were cut and allowed to bleed into a bowl. People believed that regular bleeding would keep you healthy. So monks were given regular blood letting sessions.

Medieval doctors also prescribed laxatives for purging. Enemas were given with a greased tube attached to a pigs bladder.

Doctors also prescribed baths in scented water. They also used salves and ointments and not just for skin complaints. Doctors believed it was important when treating many illnesses to prevent heat or moisture escaping from the effected part of the body and they believed that ointments would do that.

Medieval doctors also examined a patient's urine. The color, smell and even taste of urine were important.

Astrology was also an important part of Medieval medicine. Doctors believed that people born under certain zodiacal signs were more susceptible to certain ailments.

In the 13th century a new type of craftsmen emerged in towns. He (or she because not all were male) was the barber-surgeon. They cut hair, they pulled teeth and they performed simple operations such as amputations and setting broken bones.

In the Middle Ages the church ran the only hospitals. (Although often the only thing they could do was offer food and shelter). In many towns monks and nuns cared for the sick as best they could.

Furthermore outside many towns were leper 'hospitals' (really just hostels as nothing could be done for the patients). Leprosy was a dreadful skin disease. Anyone who caught it was an outcast. They had to wear clothes that covered their whole body. They also had to ring a bell or a wooden clacker to warn people they were coming. Fortunately leprosy grew less common in the 15th century and it died out in Britain in the 16th century.

In the Middle Ages only monasteries had sanitation. Streams provided clean water. Dirty water was used to clear toilets, which were in a separate room. Monks also had a room called a laver where they washed their hands before meals.

However for most people sanitation was non-existent. In castles the toilet was simply a long passage built into the thickness of the walls. Often it emptied into the castle moat. Despite the lack of public health many towns had public bath-houses were you could pay to have a bath.

From the mid-14th century the church allowed some dissections of human bodies at medical schools. However Galen's ideas continued to dominate medicine and surgery.

MEDICINE IN THE 16th CENTURY

During the 16th century there were some improvements in medicine. However it remained basically the same as in the Middle Ages. Medicine was still dominated by the theory of the four humors. In 1546 a man Girolamo Fracastoro published a book called On Contagion. He suggested that infectious diseases were caused by 'disease seeds', which were carried by the wind or transmitted by touch. Unfortunately there was no way of testing his theory.

In 1478 a book by the Roman doctor Celsus was printed. (The printing press made all books including medical ones much cheaper). The book by Celsus quickly became a standard textbook. However in the early 16th century a man named Theophrastus von Hohenheim (1493-1541) called himself Paracelsus (meaning beyond or surpassing Celsus). He denounced all medical teaching not based on experiment and experience. However traditional ideas on medicine held sway for long afterwards.

However surgery did become a little more advanced in the 16th century. Leonardo Da Vinci (1452-1519) dissected some human bodies and made accurate drawings of what he saw.

However the greatest surgeon of the age was Andreas Vesalius (1514-1564). He did many dissections and realized that many of Galen's ideas were wrong. In 1543 he published a book called The Fabric of the Human Body. It contained accurate diagrams of a human body. Vesalius's great contribution was to base anatomy on observation not on the authority of writers like Galen.

Another great surgeon was Ambroise Pare. In the 16th century surgeons put oil on wounds. However in 1536 during the siege of Turin Pare ran out of oil. He made a mixture of egg whites, rose oil and turpentine and discovered it worked better than oil. Pare also designed artificial limbs.

In 1513 a man named Eucharius Roslin published a book about childbirth called Rosengarten. In 1540 an English translation called The Birth of Mankind was published. It became a standard text although midwives were women.

Syphilis was common in the 16th century. The standard treatment was mercury administered with a urethral syringe. In the 16th century syringes were also used to irrigate wounds with wine.

MEDICINE IN THE 17TH CENTURY

In the 17th century medicine continued to advance. In the early 17th century an Italian called Santorio invented the medical thermometer.

In 1628 William Harvey published his discovery of how blood circulates around the body. Harvey realized that the heart is a pump. Each time it contracts it pumps out blood. The blood circulates around the body. Harvey then estimated how much blood was being pumped each time.

Unfortunately in the 17th century medicine was still handicapped by wrong ideas about the human body. Most doctors still thought that there were four fluids or 'humors' in the body, blood, phlegm, yellow bile and black bile. Illness resulted when you had too much of one humor. Nevertheless during the 17th century a more scientific approach to medicine emerged and some doctors began to question traditional ideas.

Apart from Harvey the most famous English doctor of the 17th century was Thomas Sydenham (1624-1689). He is sometimes called the English Hippocrates because he emphasized the importance of carefully observing patients and their symptoms.

In the 17th century medicine was helped by the microscope (invented at the end of the 16th century). Then in 1665 Robert Hooke was the first person to describe cells in his book Micrographia.

Finally in 1683 Antoine van Leeuwenhock observed microorganisms. However he did not realise they caused disease. Meanwhile in 1661 Robert Boyle

published the Skeptical Chemist, which laid the foundations of modern chemistry.

In the early 17th century doctors also discovered how to treat malaria with bark from the cinchona tree (it contains quinine).

The Chinese invented the toothbrush. (It was first mentioned in 1498). Toothbrushes arrived in Europe in the 17th century. In the late 17th century they became popular with the wealthy in England.

MEDICINE IN THE 18TH CENTURY

During the 18th century medicine made slow progress. Doctors still did not know what caused disease. Some continued to believe in the four humors (although this theory declined during the 18th century). Other doctors thought disease was caused by 'miasmas' (odorless gases in the air).

However surgery did make some progress. The famous 18th century surgeon John Hunter (1728-1793) is sometimes called the Father of Modern Surgery. He invented new procedures such as tracheotomy.

Furthermore during the 18th century a number of hospitals were founded. In 1724 Guys Hospital was founded with a bequest from a merchant named Thomas Guy. St Georges was founded in 1733 and Middlesex Hospital in 1745. Hospitals were also founded in Bristol in 1733, York in 1740, Exeter in 1741 and Liverpool in 1745. The first hospital in America opened in Philadelphia

in 1751.

In the late 18th century and early 19th century dispensaries were founded in many towns. They were charities were the poor could obtain free medicines.

In the 18th century many sailors suffered from scurvy (vitamin c deficiency). However a Scottish surgeon named James Lind discovered that fresh fruit or lemon juice could cure or prevent scurvy. He published his findings in 1753 as A Treatise on the Scurvy.

In 1792 Luigi Galvani discovered that frogs legs twitch if given an electric shock, showing that electricity plays a part in the nervous system.

A major scourge of the 18th century was smallpox. However in 1796 a man named Edward Jenner (1749-1823) realized that milkmaids who caught cowpox were immune to smallpox. He invented vaccination. (Its name is derived from the Latin word for cow, Vacca). The patient was cut then matter from a cowpox pustule was introduced. The patient gained immunity to smallpox. Unfortunately nobody knew how vaccination worked.

During the 18th century superstition declined. In 1700 many people believed that scrofula (a form of tubercular infection) could be healed by a monarch's touch. (Scrofula was called the kings evil). Queen Anne (reigned 1702-1714) was the last British monarch to touch for scrofula. Despite the decline of superstition there were still many quacks in the 18th century. Limited medical knowledge meant many people were desperate for a cure. One of the most common treatments, for the wealthy, was bathing in or drinking spa water, which they believed could cure all kinds of illness.

During the 18th century the mentally ill were not regarded as 'truly' human. It was thought that they did not have human feelings. They were therefore confined in chains. People paid to visit asylums and see the insane as if they were animals in a zoo.

However in 1793 a doctor called Philippe Pinel argued that the insane should be released and treated humanely. As an experiment he was allowed to release some patients. The experiment worked and attitudes to the insane began to change.

In 1792 a Frenchman named Dominique-Jean Larrey created the first ambulance service for wounded men.

MEDICINE IN THE 19TH CENTURY

During the 19th century medicine made rapid progress. In 1816 a man named Rene Laennec invented the stethoscope. At first he used a tube of paper. Later he used a wooden version.

In 1822 a trapper named Alexis St Martin was shot in the stomach. The wound healed leaving a hole into his stomach. A doctor named William Beaumont found out how a stomach works by looking through the hole.

During the 19th century there were several outbreaks of cholera in Britain. It struck in 1832, 1848, 1854 and 1866. During the 1854 epidemic John Snow (1813-1858) showed that cholera was transmitted by water. However doctors were not certain how.

Later Louis Pasteur (1822-1895) proved that microscopic organisms caused disease. In the early 19th century many scientists believed in spontaneous generation i.e. that some living things spontaneously grew from non-living matter. In a series of experiments between 1857 and 1863 Pasteur proved this was not so. Once doctors knew what caused disease they made rapid headway in finding cures or prevention.

In 1880 Pasteur and a team of co-workers searched for a cure for chicken cholera. Pasteur and his team grew germs in a sterile broth. Pasteur told a co-worker to inject chickens with the germ culture. However the man forgot and went on holiday. The germs were left exposed to the air. Finally, when he returned the man injected chickens with the broth. However they did not die. So they were injected with a fresh culture. Still they did not die.

Pasteur realized the germs that had been left exposed to the air had been weakened. When the chickens were injected with the weakened germs they had developed immunity to the disease.

Pasteur and his team went on to create a vaccine for anthrax by keeping anthrax germs heated to 42-43 degrees centigrade for 8 days.

In 1882 they created a vaccine for rabies. A co-worker dried the spines of rabbits that had contracted the disease in glass jars. Pasteur tried giving a series of injections made from the dried spines to animals to test the remedy. Then, in 1885, Pasteur successfully used the vaccine on a boy who had been bitten by a rabid dog.

Pasteur also invented a way of sterilizing liquids by heating them (called pasteurization). It was first used for wine (in 1864) and later for milk.

Meanwhile In 1875 Robert Koch (1843-1910) isolated the germ that causes anthrax. In 1882 he isolated the germ that causes tuberculosis and in 1883 he isolated the germ that causes cholera in humans.

Meanwhile the organism that causes leprosy was discovered in 1879. The germ that causes typhoid was isolated in 1880. The germ that causes diphtheria was discovered in 1882 by Edwin Klebs. In 1884 the germs that cause tetanus and pneumonia were both discovered.

Immunization against diphtheria was invented in 1890. A vaccine for typhoid was invented in 1896.

Surgery was greatly improved by the discovery of Anesthetics. As early as 1799 the inventor Humphrey Davy (1778-1829) realized that inhaling ether relieved pain. Unfortunately decades passed before it was actually used in an operation in 1842.

James Simpson (1811-1870), who was Professor of Midwifery at Edinburgh University, began using chloroform for operations in 1847.

In 1884 cocaine was used as a local anesthetic. From 1905 Novocain was used.

In 1865 Joseph Lister (1827-1912) discovered antiseptic surgery, which enabled surgeons to perform many more complicated operations. Lister prevented infection by spraying carbolic acid over the patient during surgery. German surgeons developed a better method. The surgeons hands and clothes were sterilized before the operation and surgical instruments were sterilized with super heated steam.

Rubber gloves were first used in surgery in 1890. Anesthetics and antiseptics made surgery much safer. They allowed far more complicated operations.

In 1851 Herman von Helmholtz invented the ophthalmoscope. In 1895 x-rays were discovered by Wilhelm Roentgen. The same year aspirin was invented.

Nursing was greatly improved by two nurses, Florence Nightingale (1820-1910) and Mary Seacole (1805-1881) who both nursed soldiers during the Crimean War 1854-56.

Meanwhile in the 19th century several more hospitals were founded in London including Great Ormond Street Children's Hospital (1852). In 1864 Jean Henri Dunant founded the international Red Cross.

During the 19th century the ancient practice of bloodletting declined. (It was still used in France, to treat pneumonia, until the 1920s).

MEDICINE IN THE 20TH CENTURY

Medicine made huge advances in the 20th century. The first non-direct blood transfusion was made in 1914. Insulin was first used to treat a patient in 1922. The EEG machine was first used in 1929. Meanwhile many new drugs were developed. In 1910 the discovered salvarsan, a drug used to treat syphilis was discovered. In 1935 prontosil was used to treat blood poisoning

Later it was discovered that the active ingredient of the dye was a chemical called sulphonamide, which was derived from coal tar. As a result in the late 1930s a range of drugs derived from sulphonamide were developed.

Antibiotics were discovered too. Penicillin was discovered in 1928 by Alexander Fleming but it was not widely used till after 1940. Another antibiotic, streptomycin was isolated in 1944. It was used to treat tuberculosis. They were followed by many others.

Meanwhile the iron lung was invented in 1928 and in 1943 Willem Kolf built the first artificial kidney machine. (The first kidney transplant was in 1963).

In Britain the health of ordinary people greatly improved when the National Health Service was founded in 1948.

In 1953 Dr Jonas Salk announced he had a vaccine for poliomyelitis. A vaccine for measles was discovered in 1963.

Meanwhile surgery made great advances. The most difficult surgery was on the brain and the heart. Both of these developed rapidly in the 20th century. The external pacemaker was invented by a Canadian called John Hopps in 1950. The first implantable pacemaker was given to a patient in 1958. The first heart transplant was performed in 1967. The first artificial heart was installed in 1982. The first heart and lung transplant was performed in 1987.

The laser was invented in 1960. In 1964 it was used in eye surgery for the first time.

Meanwhile the invention of fiber optics in the 1950s made possible the development of endoscopes in the 1960s.

Treatment for infertility also improved in the late 20th century. The first test tube baby was born in 1978.

In the late 20th century medicine continued to develop rapidly. In 1980 the World Health Organisation announced that smallpox had been eradicated. However in 1981 a terrible new disease called AIDS was isolated.

Meanwhile in 1975 Computerized Axial Scanning or CAT was introduced. In 1983 Magnetic Resonance Imaging or MRI was introduced. Synthetic skin was developed in 1986 and gene therapy was introduced in 1990.

MEDICINE IN THE 21ST CENTURY

In the early 21st century new types of transplant were performed. In 2005 the first face transplant took place. Then in 2011 the first leg transplant was carried out. Finally in 2012 the first womb transplant was carried out.